Chest Pain 3 — Transcript

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1. 0:15scribe
2. 0:15jake what brought you in to see us today
3. 0:18um
4. 0:18well i was at work and i had i was
5. 0:21sitting there and all of a sudden i got
6. 0:22really dizzy
7. 0:24so i sat down which kind of helped but
8. 0:26not really
9. 0:27so an hour later then i started to get
10. 0:29this really heavy
11. 0:31chest pain so i tried a chewable aspirin
12. 0:35and it kind of helped then i started to
13. 0:37get really sweaty
14. 0:38and so i was like i just need to lay
15. 0:40down so i laid down for a little bit
16. 0:42it kind of helped but then the chest
17. 0:44came pain came back
18. 0:46so i tried a nitro and that didn't
19. 0:49really work either
20. 0:50so i was just so then i called the squad
21. 0:53okay
22. 0:53have you ever had anything like this
23. 0:54before in the past no okay
24. 0:57did you have any associated symptoms
25. 0:58like shortness of breath
26. 1:00no were you nauseated yeah
27. 1:04have you had any cough or congestion no
28. 1:06any leg pain or leg swelling no
29. 1:08any history of cardiac disease no do you
30. 1:11have any high cholesterol
31. 1:12yeah do you have diabetes no do you have
32. 1:14any high blood pressure
33. 1:15yeah have you ever seen a cardiologist
34. 1:18um
35. 1:20yeah because they gave me medications
36. 1:21but i don't take them okay
37. 1:23um do you have a list of your
38. 1:25medications i could look through or did
39. 1:26you give them to the nurse
40. 1:27yeah you came to the nurse okay i'll
41. 1:29take a look um how long have you been
42. 1:30off your medications
43. 1:32um i don't i don't remember it's a long
44. 1:34time yeah okay
45. 1:35um we'll have to make sure we check your
46. 1:37blood pressure and see if it's elevated
47. 1:38today that does make you a higher risk
48. 1:40for heart attack and stroke
49. 1:41okay do you smoke cigarettes no okay are
50. 1:43you having the chest pain now
51. 1:45i'm just a little yeah does it radiate
52. 1:47anywhere no but like
53. 1:48the past couple weeks my left arm has
54. 1:51been really numb and tingly and it got
55. 1:54a lot worse today which also made me
56. 1:55kind of nervous so that's
57. 1:57also why i called the squad too okay and
58. 2:00some other routine questions any history
59. 2:02of
60. 2:02dvt pe bleeding or clotting disorder
61. 2:06any history of cancer recent travel
62. 2:08recent surgery
63. 2:09any history of um
64. 2:12cancer no okay any other symptoms that i
65. 2:16didn't ask about recent cold cough
66. 2:17congestion
67. 2:18diarrhea belly pain could you be any bad
68. 2:20food causing you have reflux or blood in
69. 2:22your
70. 2:23stool or anything like that okay good
71. 2:25all right
72. 2:49i think she's got a systolic murmur it's
73. 2:51about two out of six
74. 2:54take a deep breath
75. 2:57deep breath deep breath
76. 3:06she has some fine crackles loudest at
77. 3:08the bases
78. 3:09no respiratory distress
79. 3:14she does have equal radial pulses
80. 3:18does this hurt when i push here no okay
81. 3:20no calf tenderness
82. 3:22she does have plus two pitting edema
83. 3:26well i think what we need to do is a
84. 3:27cardiac evaluation primarily that's the
85. 3:28concern that i have with it radiating to
86. 3:30your left arm and your other symptoms
87. 3:32we'll get an ekg a cbc a bmp
88. 3:36a troponin with the crackles i think we
89. 3:38should go ahead and get a bnp
90. 3:40we'll get a chest x-ray to look for
91. 3:42fluid on your lungs
92. 3:44how old are you i'm like 30.
93. 3:47okay we'll get a urine pregnancy test as
94. 3:49well um
95. 3:51and um let's go ahead and get a d-dimer
96. 3:54i don't think she's got a pe but she
97. 3:56does have some
98. 3:57shortness of breath so all right um
99. 4:01let's give you something for your pain
100. 4:02how many aspirin did you take today just
101. 4:04the one okay but the squad did give me
102. 4:05something they gave me a nitro
103. 4:07and some fentanyl also but that didn't
104. 4:09really help either it didn't help did it
105. 4:10do anything at all
106. 4:11i mean just a little bit but not really
107. 4:13okay so she's already had aspirin make
108. 4:15sure you put that in the note let's go
109. 4:16ahead and give her some more nitro
110. 4:18and see if that helps we'll get three
111. 4:20sublingual nitro total
112. 4:21and then we'll have to put on a nitrogen
113. 4:23if that does help otherwise we can give
114. 4:24her some morphine
115. 4:25and i'll make sure and check your vital
116. 4:27signs and make sure your blood
117. 4:28pressure's not elevated
118. 4:29and uh those medications may bring your
119. 4:32blood pressure down as well
120. 4:33okay all right and i'll be back to check
121. 4:34on you let me know if that helps okay
122. 4:36thank you